| NPI | 1982043030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0013789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0055689) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2022-05-10 |